Provider Demographics
NPI:1043343221
Name:POWELL, RANDAL G (DC)
Entity Type:Individual
Prefix:DR
First Name:RANDAL
Middle Name:G
Last Name:POWELL
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:RANDY
Other - Middle Name:
Other - Last Name:POWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:551 W TURKEYFOOT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-3450
Mailing Address - Country:US
Mailing Address - Phone:330-644-5050
Mailing Address - Fax:330-644-5621
Practice Address - Street 1:551 W TURKEYFOOT LAKE RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-3450
Practice Address - Country:US
Practice Address - Phone:330-644-5050
Practice Address - Fax:330-644-5621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1096111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000036583OtherBLUE CROSS BLUE SHIELD
OH000000036583OtherBLUE CROSS BLUE SHIELD
OH0622621Medicare ID - Type Unspecified